This is an HTML version of an attachment to the Official Information request 'Standards for Head Injury (1995)'.

03 December 2018 
Anthony Jordan  
[FYI request #9010 email] 
Dear Mr Jordan                       
                                          Ref: 0053110 
Official Information Act Request 
Thank you for your email of 6 November 2018 asking for the following information under the 
Official Information Act 1982 (the Act): 
Please provide a copy of the draft  'Standards for Head Injury Services' prepared in 
September 1995
Our Response 
Unfortunately, despite reasonable efforts to locate  the  Standards for Head Injury Services 
draft  prepared  in 1995, ACC  has been  unable to locate this  document. For this reason,  we 
refuse your request under section 18(e) of the Act.  
Injury Strategy 
We can however, provide some information that you may find  helpful. The Traumatic Brain 
Injury Strategy and Action Plan (2017-2012)  
is  guiding ACC to  prevent  and reduce  the 
incidence, severity and impacts of traumatic brain injury. This supersedes the Standards for 
Head Injury Services 
with updates and guidelines, reflecting best rehabilitation practice.  I 
have attached a copy of this document to this letter.  
If you have any questions about the information provided, ACC will be happy to work with 
you to resolve these. Please send 
your questions by email to 
[email address]. 
You also have the right to seek an investigation and review of this response,  by the 
Information about how to make a complaint is available at or by phoning 0800 802 602. 
Yours sincerely 
Government Engagement & Support 

Traumatic Brain Injury Strategy  
and Action Plan (2017 – 2021)
 Improve the quality of life of New Zealanders by reducing the 
incidence, severity and impacts of traumatic brain injury. 

Traumatic Brain Injury Strategy and Action Plan 2017–2021
Published in September 2017 by ACC 
Wellington, New Zealand
ACC7819 September 2017
This document is available at

Traumatic brain injuries can happen to anyone, at any time, 
with life-changing impacts – for those who sustain the injury, 
their whānau and our wider society.
At ACC, we want to do everything we can to help prevent these injuries, 
and to ensure that those who are injured get the best treatment and 
rehabilitation possible. We know we can achieve better results through 
partnering and collaboration with others, to improve the quality of life of 
New Zealanders.
This document describes our strategic direction for the next five years. It 
includes a strong focus on injury prevention, children, and mild traumatic 
brain injury, which complements the work done since 2012 to improve 
outcomes for adults with moderate to severe traumatic brain injuries.
The refreshed strategy is bold and ambitious. It has practical actions 
that target improvements across the system and working with other 
government agencies. Importantly, at the heart of it lies a strong client 
and whānau focus. This demonstrates a high level of commitment 
by government agencies to work together to achieve positive change 
and improve outcomes for people at risk of, or who have, traumatic 
brain injuries. 
I would like to acknowledge everyone who has contributed their time, 
knowledge and experience to the development of this important strategy 
and action plan. We have had expert advice from many people who have 
sustained traumatic brain injuries and their whānau, as well as service 
providers and government agencies.
For all of us, reducing the incidence, severity and impacts of traumatic 
brain injury for New Zealanders is a significant priority. I am confident 
that this strategy and action plan will help deliver on this vision.
Jim Stabback
Deputy Chief Executive

Why New Zealand needs a TBI Strategy and Action Plan 1
Kupu arataki: introduction 
Ngā honohono: linkages 
Ngā hiahia: our aims  
Te wawata: vision 
Te aronga: purpose 

Ngā whai tikanga: priorities 

Ngā tohutohunga: guiding principles 

Strategy on a page 
Action timeline 
Implementation and governance 
Priority 1: TBIs are prevented 
Priority 2: TBI prevention, diagnosis, treatment 
and rehabilitation are effective 
Priority 3: People with TBIs and their whānau 
experience good outcomes 
Priority 4: Workforce capability in TBI is developed 
Roadmap: Planning to support the 
implementation of actions 
Appendix 1: Additional principles 
Appendix 2: Current high relevance programmes 
References 40

ACC would like to thank the many people who contributed to the development of this 
Traumatic Brain Injury Strategy and Action Plan and willingly shared their time, personal 
experience and vast wealth of knowledge. The input of many individuals, whānau and 
organisations with personal and professional experience of traumatic brain injuries was 
vital in shaping this strategy and action plan.

Why New Zealand needs a TBI 
Strategy and Action Plan
Kupu arataki: introduction
Mild TBIs are commonly referred to as concussions. 
ACC held data indicates that of those people with 
This Traumatic Brain Injury Strategy and 
mild TBIs, 10-12% need extra support beyond 
Action Plan reflects the Accident Compensation 
primary healthcare monitoring after their injuries. 
Corporation’s (ACC’s) continued commitment 
Approximately 1,200-1,500 people suffer moderate 
to addressing the challenges of preventing and 
TBIs and 1,750 people suffer moderate to severe 
managing traumatic brain injury (TBI), while 
TBIs each year. Five hundred of these people go 
working alongside cross-government partners, 
on to receive specialised residential rehabilitation. 
service providers, ACC clients and their whānau. 
About one in every 8-10 people will not seek medical 
assistance or report their TBI to ACC. 
TBIs can have a profound effect on the person and 
their whānau. When a TBI affects a person’s quality 
About 20% of concussions/mild TBIs in sport are 
of life it also affects the community and the economy. 
missed. This increases the risk of sustaining a more 
severe TBI. To minimise the risk of second-impact 
syndrome, where a second injury to the brain 
occurs before the first fully resolves, preventing and 
TBI is defined as an alteration in brain function, or 
identifying concussion in sports is a current focus 
other evidence of brain pathology, caused by an 
for ACC. 
external force (Carroll, Cassidy, Holm, Kraus, and 
While TBIs can affect men and women of all ages, 
Coronado, 2004). It can be caused by a blow, shake 
males are twice as likely as females to sustain 
or jolt to the head or body or a penetrating injury 
moderate or severe TBIs. People living in rural areas 
that disrupts the function of the brain. 
also have more than twice the risk of moderate or 
severe TBIs than people who live in urban areas, 
TBIs occur frequently
mainly due to transport accidents. 
International evidence, including a recent  
Infants, children and adolescents are at greater 
New Zealand study, suggests that TBI among the 
risk of TBIs than any other age groups. Māori and 
general population is significantly undercounted 
Pacific people are overrepresented in TBI statistics 
because people with mild TBIs do not always seek 
(Lagolago et al., 2015). Māori were found to have 
medical treatment (Feigin et al., 2013). In  
a 23% greater risk of mild TBIs than New Zealand 
New Zealand it is estimated that up to 36,000 
Europeans in the Bionic Study 1 (Feigin et al., 2013).
people suffer TBIs each year, of which 95% are mild. 
The majority do not seek medical assistance or 
TBIs have multiple causes
report this to ACC. 
The leading causes of TBI in New Zealand are falls, 
ACC statistics show that nearly 14,000 people are 
mechanical forces, driving-related accidents and 
treated for TBIs each year. The cost of TBI-related 
assaults 2. 
claims was $83.5 million in the 2015 financial year. 
TBI is a growing problem in New Zealand, with 
Just over 20% of all TBIs in New Zealand are 
over half of ACC’s serious injury claims relating to 
sustained through sport-related activity. 
TBI. The New Zealand Treasury has identified that 
Most TBIs occur in communities and homes.
TBIs are second only to stroke for their impacts on 
employment and income (Dixon, 2015). 
 1   The Brain Injury Outcomes New Zealand in the Community (BIONIC) study identified all cases of TBI within a one year period in the Hamilton and 
Waikato regions of New Zealand. The study has been assessing people over the course of their recovery journeys (latest assessments conducted at four 
years post-injury).
 2   Refers to physical injuries purposefully inflicted onto a person. Other terms used in the document that also refer to physical injuries due to assaults are 
non-accidental injuries and intentional injuries.

TBIs have significant impacts
Current system
TBIs can range from mild concussion (a brief change 
According to people with TBIs, and their whānau, 
in mental status or consciousness) to severe (an 
the current system is fragmented and does not 
extended period of unconsciousness and/or memory 
support the achievement of the best possible results. 
loss after the injury). The effects can be temporary 
These views are depicted in the diagram below.
or permanent. Recent evidence suggests that 
recovery after a mild TBI has a longer trajectory 
Current work to prevent TBIs 
than previously thought (Barker-Collo et al., 2015; 
Theadom et al., 2015). Many people who experience 
A number of significant partnerships and 
TBIs have long-term or lifelong disabilities that affect 
programmes, as well as data and research, are 
their whānau, the community and the economy.
helping to prevent TBI and improve outcomes for 
TBI can affect a person’s quality of life due to the 
those with TBIs.
cognitive, behavioural, emotional and physical 
Most injury prevention programmes involve agencies 
effects on their ability to live independently, 
and groups working in partnership, taking a person-
maintain relationships and return to work or 
centred approach to achieving population-level 
education and leisure activities. 
reductions in the incidence and severity of injuries. 
The burden of TBI in New Zealand is substantial 
The injury prevention programmes most relevant to 
and linked to other health and social factors. The 
TBI target caregivers of infants, children and older 
impacts of TBI are only partly determined by the 
people, alcohol and drug-related harm, and sport. 
nature and severity of the injury. Other equally 
Prevention activities are also directed towards the 
important factors include the person’s age, their 
workforce to equip them to contribute to reducing 
health prior to the injury, their living situation and 
the incidence, severity and impacts of TBI. 
their socio-cultural and economic circumstances. 
Appendix 2 has a brief description of these 
TBI’s Current System Diagram (pg 4)
TBI is a leading cause of long-term disability among 
children and young adults.
I don’t understand
• Insufficient information limits the ability for the person to cope 
or access support and services
• Families don’t know what to expect and how to respond
What’s wrong with me?
• TBI goes unrecognised
• TBI diagnosed late
• Early treatment not sought
What about me?
• Impacts on families not considered
• Experience of services and support not known
• TBI treated in isolation of personal circumstances
• Services are a ‘one size fits all’
Poor coordination
• Services and support provided in isolation of each other
• Rehabilitation gains lost when delays to services occur
• Other services have limited information to respond appropriately

Current work to improve the  
the need for a systems approach 5 and the need to 
client journey 
target Māori who are at higher risk of TBI.
Almost 400 people worked alongside ACC to refresh 
ACC is part of the Whole of Pathways TBI 
the TBI Strategy and develop the action plan. 
Collaborative – a programme in the Auckland 
They included people with TBIs, their whānau, 
region that uses Collective Impact 3 working 
service providers, support organisations and other 
alongside clients, whānau, consumer organisations, 
government agencies.
rehabilitation providers, primary healthcare 
providers, district health boards and the Ministry 
of Health to achieve improvements in the client 
Nga honohono: linkages
journey for adults with moderate to severe TBIs. 
Changes to date that have the potential to directly 
The development of this TBI Strategy and Action 
affect client outcomes include improvements in:
Plan recognises that a focus on TBI is a national 
health priority.
•  access to information about TBIs for clients and 
Its initiatives do not stand alone; they link 
with several other strategies, plans and work 
•  how providers work together to ensure an 
programmes within ACC and across government 
integrated approach
that share a focus on injury prevention and 
•  processes between ACC and district health boards 
strengthening services, support and workforce 
•  transitions between services to avoid delays and 
maintain rehabilitation momentum for clients.
These include:
Work is also underway to improve the collection and 
•  ACC’s Injury Prevention Strategy
use of data that provides a system-level view using 
•  the New Zealand Health Strategy 2016 6 
the six domains 4 of healthcare quality.
•  the Healthy Ageing Strategy 7 
The Whole of Pathways TBI Collaborative provides 
a useful platform for developing and testing 
•  He Korowai Oranga: Māori Health Strategy 8 
improvements that can then be applied nationally.
•  Whāia Te Tika: ACC’s Māori Strategy 
Previous strategy
•  Whānau Ora 9
•  the New Zealand Disability Strategy 2016-2026 10
ACC first developed a TBI Strategy in 2012, providing 
a direction for several significant improvements in 
•  the New Zealand Carers’ Strategy Action Plan for 
TBI services for adults with moderate and severe 
2014 to 2018 11
TBIs, including residential rehabilitation. 
•  ACC’s Transformation Programme 12 
Phase two of the TBI Strategy was undertaken 
•  the ACC Provider Service Delivery Health Sector 
in 2014. It introduced a focus on children, injury 
prevention and the full spectrum of TBIs and was 
used as the basis of this TBI Strategy and Action Plan. 
•  the Children’s Action Plan
The TBI Strategy and Action Plan (2017–2021) builds 
•  Better Public Services targets relevant to health 
on the previous strategy’s successful programmes 
and injuries (Ministry of Health, June 2017) 13 
and initiatives, while striving to achieve more than 
•  the Transformation Programme for the Ministry 
incremental improvements by establishing key 
for Vulnerable Children, Oranga Tamariki.14
partnerships that recognise the role of whānau, 
3    Collective Impact is an innovative and structured approach to making collaboration work across funders, providers, other organisations, clients and 
their whānau to achieve significant and lasting change.  
4   Six domains of healthcare quality uses the Institute of Medicine (IOM) framework which considers safety, effectiveness, patient-centred, timeliness, 
efficacy and equity. 
 5   A whole of systems approach considers the entire pathway of care improving coordination of professional and organisational boundaries to achieve 
high-quality services irrespective of their location where the combined impact of a range of services is greater than any single service.
 6  See
 7  See 
 8  See
 9  See
 10  See 
 11  See 
 12  See
 13  Well Child/Tamariki Ora workforce development. 
 14  See

Nga hiahia: our aims
Te wawata: vision
Nga whai tikanga: priorities 
The TBI Strategy’s vision is to improve the quality 
The priorities for the TBI Strategy and Action Plan 
of life of New Zealanders by reducing the incidence, 
have been based on:
severity and impacts of TBI. 
•  engagement meetings with ACC clients and their 
whānau, rehabilitation providers, consumer 
Te aronga: purpose
groups and organisations, district health boards, 
universities and government agencies as part of 
The overarching purpose of the TBI Strategy and 
a co-design process 
Action Plan is to guide key initiatives that will:
•  current partnerships and work programmes in the 
•  deepen the focus of injury prevention activities 
wider sector
specific to TBI that ultimately contribute to 
reducing the incidence and severity of moderate 
•  the extent to which TBI is unique in the issues and 
to severe TBI 
opportunities identified 
•  work with Māori and other ethnicities who are 
•  the ability to make or influence change.
overrepresented in all TBI statistics 
To achieve the vision, the following strategic 
•  enable people with TBIs to achieve maximum 
priorities have been identified. 
and satisfying participation at home, school and 
Each priority has interrelated aspects and 
work and in the community, consistent with their 
associated goals:
rehabilitation goals
TBIs are prevented
•  recognise the interdependent relationship 
between people with TBIs and their whānau 
•  TBI is prioritised within existing and future ACC 
•  improve cross-government and systems 
injury prevention activities, driving changes 
integration that in turn improves access to,  
that positively influence risk-taking behaviours 
and the coordination of, services and support
associated with TBI. 
•  strengthen and extend workforce capabilities 
•  New injury prevention initiatives are established 
to achieve best practice in the prevention, 
that target TBI prevention.
recognition and management of TBI
•  reduce the economic burden of TBI.
TBI prevention, diagnosis, treatment and 
rehabilitation are effective
•  Best practice informs nationally consistent 
assessment/diagnosis and the delivery of TBI 
services and support. 
•  Services are culturally responsive and inclusive 
of whānau.
•  Outcomes and experiences of service delivery are 
collected and used to support improvements. 
•  Government agencies work together to achieve an 
integrated approach. 

TBI’s Visions Diagram (pg 7)
TBI prevention, 
People with TBIs 
diagnosis, treatment 
and their whānau 
and rehabilitation are 
experience good 
Workforce capability 
TBIs are prevented
in TBI is developed
Improve the quality of 
life for New Zealanders 
by reducing the 
incidence, severity and 
impacts of TBI
People with TBIs and their whānau 
experience good outcomes
1.  Uphold the principles of Whāia Te Tika:  
•  People with TBIs and their whānau understand 
ACC’s Māori Strategy.
and adapt to their changing circumstances.
2.  Uphold the principles of the Convention on the 
•  Rehabilitation momentum is maintained when 
Rights of Persons with Disabilities.
people move within or between services and 
3.  Uphold the principles of the United Nations 
Convention on the Rights of the Child.
Workforce capability in TBI is developed
4.  Identify the right areas of focus and investment 
by being informed by evidence.
•  Workforce resources and skills match the needs of 
5.  Achieve a person and whānau-driven focus 
people requiring TBI services.
across services and support. 
•  Government agencies and others working with 
6.  Improve the consistency and quality of services 
people with TBIs improve their knowledge of TBI. 
to maximise outcomes for people with TBIs and 
Each goal has one or more actions, which are 
their whānau.
informed by current work programmes and areas 
7.  Commit to improving health equity that 
identified as part of the engagement and co-design 
addresses multiple determinants of health that 
of this strategy and action plan. 
we can influence. 
8.  Involve our customers in setting priorities and 
Nga tohutohunga: guiding 
co-designing service changes.
9.  Work in partnership with other agencies 
to achieve a more integrated and holistic 
The following principles guide decision-making 
approach to preventing and reducing the 
and the way the TBI Strategy and Action Plan is 
impacts of TBI.
implemented. These principles are important as 
the New Zealand health and disability system 
The principles of Whāia Te Tika: ACC’s Māori 
continues to shift from a siloed system towards a 
Strategy, the Convention on the Rights of 
more integrated system that considers each person 
Persons with Disabilities and the United Nations 
in their context, and wider determinants of health.
Convention on the Rights of the Child can be found 
in Appendix 1.

Strategy on a page
TBI’s Strategy Diagram (pg 10)
TBIs are prevented
• TBI is prioritised within existing and future ACC injury prevention 
activities, driving changes that positively influence risk-taking 
behaviours associated with TBI
• New injury prevention initiatives are established that target 
TBI prevention
Incidence and severity of TBI is reduced
TBI prevention, diagnosis, treatment and 
rehabilitation are effective
• Best practice informs nationally consistent 
assessment/diagnosis and delivery of TBI services and support
• Services are culturally responsive and inclusive of whānau
• Outcomes and experiences of service delivery are collected and 
used to support improvements
• Government agencies work together to achieve an integrated 
Improve the quality of life 
for New Zealanders 
Severity and impacts of TBI are reduced
by reducing the incidence, 
severity and impacts of TBI

People with TBIs and their whānau experience 
good outcomes
• People with TBIs and their whānau understand and adapt to their 
changing circumstances
• Rehabilitation momentum is maintained when people move 
within or between services and support
Impacts of TBI are minimised and people live well with TBIs
Workforce capability in TBI is developed
• Workforce resources and skills match the needs of people 
requiring TBI services
• Government agencies and others working with people with TBIs 
improve their knowledge of TBI
People with TBIs are able to maximise their potential
Uphold the principles of Whāia Te Tika: ACC’s Māori Strategy
Uphold the principles of Whāia Te Tika: ACC’s Māori Strategy
Uphold the principles of the Convention on the Rights of Persons with Disabilities
Uphold the principles of the United Nations Convention on the Rights of the Child
Uphold the principles of the United Nations Convention on the Rights of the Child
Identify the right areas of focus and investment by being informed by evidence
Identify the right areas of focus and investment by being informed by evidence
Achieve a person and whānau driven focus across services and support
Improve the consistency and quality of services to maximise outcomes for people with TBI, their family and whānau

Achieve a person and whānau-driven focus across services and support
Commit to improving health equity that addresses multiple determinants of health which we can influence
Improve the consistency and quality of services to maximise outcomes for people with TBIs and their whānau
Involve our customers in setting priorities and co-designing service changes
Commit to improving health equity that addresses multiple determinants of health that we can influence
Work in partnership with other agencies to achieve a more integrated and holistic approach to preventing and reducing impacts o
Involve our customers in setting priorities and co-designing service changes
Work in partnership with other agencies to achieve a more integrated and holistic approach to preventing and reducing the impacts of TBI

Action timeline
A timeline for the intended completion of activities, or moving programmes into business as usual, 
Action Timeline Diagram (pg 11)
of 22 actions associated with the priorities is shown below.
• Strengthen TBI information for people with TBIs and their whānau
• Deliver a service roadmap based on a person’s journey through multiple 
• Deliver a directory of services used across agencies
• Deliver a suite of national clinical pathways
• Pilot a Sports Concussion Centre of Excellence
• Deliver a group education programme for people with TBIs 
and their whānau 
• Establish a mental health and TBI programme
• Encourage the uptake of safer cars for young drivers
• Reduce the incidence and impacts of motorcycle crashes
• Establish a data and outcomes work programme
• Deliver Ministry of Education and Schools workforce TBI capability 
• Support a TBI focus in unregulated sports
• Deliver an integrated service model to support transitions of care
• Focus on TBI for Māori/Pacific people within existing ACC injury prevention 
• Determine the role of screening for TBI within the Ministry for Vulnerable 
Children, Oranga Tamariki and the Department of Corrections
• Establish a non-accidental injury prevention work programme
• Work alongside Māori to deliver a Whānau Ora service model
• Deliver a professionalised peer support programme
• Identify and share workforce resources
• Contribute to building workforce capacity in specific cultures and 
professional groups
• Deliver a workforce TBI and cultural mentoring programme
• Support development of specific TBI workforce competencies

Implementation and governance
Systems view
Stakeholder relationships
A systems approach is required to achieve effective 
To achieve a systems approach, existing 
changes. ACC needs to co-design changes with 
partnerships with ACC client groups, funders, 
people with TBIs and their whānau, working 
health professionals and other providers of support 
alongside other government agencies and 
for people with TBIs need to be maintained. Other 
relationships, such as those with some government 
TBI’s Strategy Visions Diagram (pg 12)
agencies, need to be developed and strengthened.
A responsive system will support achieving the 
TBI Strategy’s vision.
I’m aware
• Precautions taken to prevent TBI
• Early recognition and treatment
It’s about me
• Treatment considers personal circumstances
• Impacts on families are considered
• Timely rehabilitation
quality of life
I'm receiving the best
• Services match my needs
• Other services are responsive and coordinated
• My experience of TBI services makes a difference
I understand
• Information empowers and improves access to services 
and support

Evaluating effectiveness
ACC is responsible for implementing the 
An early task to support the implementation of the 
TBI Strategy and Action Plan. Successful 
TBI Strategy and Action Plan will be developing a 
implementation is dependent on:
framework for measuring the effectiveness of each 
•  shared cross-sector leadership and accountability 
goal’s implementation, to ensure that:
for implementation 
•  targets and indicators are identified, eg impacts 
•  partnering with people who are at risk and have 
and outcomes
TBIs, and their whānau
•  information sources are identified and  
•  working alongside service providers, other 
data-gathering methods are agreed (and meet 
organisations and government agencies. 
privacy of information requirements) 
ACC will establish a governance group to provide 
•  decisions are made on how often data will 
direction to, and oversight of, the work programmes 
be collected and who will be responsible for 
that arise from the TBI Strategy and Action 
collecting it 
Plan. The members will include ACC clients (or 
•  meaningful engagement continues with TBI 
representatives) and representatives of government 
clients, their whānau and the wider sector
agencies and other organisations.
•  proxy measures are developed where suitable 
Members of the group will have decision-making 
data is not available.
authority and the ability to approve the allocation of 
resources for the completion of actions. 
It is important that the governance group monitors 
progress in implementing the TBI Strategy and 
Action Plan at least twice yearly. This will also provide 
opportunities to modify actions in response to sector 
changes that may occur over the five year period. 
Implementation approach
It is recommended that a steering group be 
established to ensure that activities across multiple 
actions are aligned. 
Existing programmes, such as the Whole of Pathways 
TBI Collaborative work programme, can be extended 
as one means of gaining early traction on meeting 
some of the strategic goals within each priority. 


Priority 1:
TBIs are prevented
Hazel and Matt are first-time parents of a four-week-old baby, Manu.  
They were excited and nervous about becoming parents. Hazel attended 
antenatal classes and Matt went with her whenever he could. The antenatal 
classes prepared them for birthing and also provided information about 
infant development. They learned that babies cry a lot and about things they 
could do to cope with the crying. The classes provided information that could 
be taken home and shared with friends and family. This was great for Matt as 
he could catch up on missed classes. 
Hazel and Matt have friends who are parents and often talk to them about 

parenting. They are finding that their experience of parenting is really 
different from those of their friends, as Manu was born five weeks premature. 
Matt’s work requires travelling for days at a time and Hazel is often alone 
with the baby. 
Manu has recently started crying a lot more often. This has left Hazel feeling 

as if she isn’t a good mother and too ashamed to ask for help. She has been 
feeling exhausted as well. When her midwife comes to visit, she asks Hazel 
how she is coping with the baby’s crying – whether she has been able to 
figure out what the baby needs, and what she does if the baby keeps crying. 
The midwife reassures Hazel that it is normal for babies to cry and for her to 
feel overwhelmed and stressed out by this. 
The midwife helps Hazel to explore some ways she can deal with her stress 

and identify support for her and Matt. She also advises Hazel to see her GP 
about Manu’s crying. The midwife asks Hazel to put her plan on what to 
do if Manu doesn’t stop crying on the fridge and to let Matt know about it. 
This has helped Matt, as whenever he has to travel he makes up a roster 
with their friends so that someone comes in every day to give Hazel some 
company, or help out if she needs it. 

•  ACC is developing an Alcohol and Drug Strategy 
that includes actions to reduce severe and 
ACC has a comprehensive approach to injury 
catastrophic injuries, of which TBI will be a part.
prevention. This includes collaborating with a range 
of stakeholders, a cross-government and cross-
•  ACC is working with the Institute of 
sector injury prevention work plan, using evidence 
Environmental Science and Research (ESR) to 
and data to design programmes, and targeting 
co-design an ACC-wide family violence and child 
areas of focus within injury prevention portfolios. 
protection policy that incorporates a prevention 
and response system.
Existing injury prevention programmes that have a 
focus on preventing TBI are outlined below.15
•  ACC suicide prevention service design with 
Waikato District Health Board. 
•  Improving falls and fracture service outcomes  
for older people. 
•  ACC is a member of the Ministerial Group on 
Family Violence and Sexual Violence. This 
•  Sports concussion in New Zealand.
includes Integrated Safety Response pilots in 
•  Road safety programmes, including education 
Christchurch and Waikato involving local ACC 
and training for young drivers and motorcycle 
teams at an operational level. 
training programmes.
As significant injury prevention work already 
•  Well Child/Tamariki Ora workforce development 
includes a consideration of TBI, the following areas 
in injury prevention, age and stage appropriate, 
have been identified as having additional impacts 
including TBI rehabilitation.
on preventing TBI.
•  Plunket’s child falls prevention training for  
its staff.
•  The Plunket Board Injury Prevention Framework.
TBI is prioritised within existing and future ACC 
injury prevention activities, driving changes 
•  Safekids Aotearoa’s ‘Make Your Home a Safety 
that positively influence risk-taking behaviours 
Zone’ campaign, with a focus on Māori and Pacific 
associated with TBI
families and priority areas across New Zealand.
Although most current injury prevention 
•  St John, Wellington Free Ambulance and 
programmes include TBI, there is an opportunity to 
the National Telehealth Service – TBI injury 
further prioritise TBI prevention – eg by including 
prevention resource development.
further targeting of Māori and Pacific people within 
•  Investment in Power to Protect – a shaken-baby-
existing and future ACC injury prevention activities. 
syndrome prevention programme managed by the 
New injury prevention initiatives are established 
Ministry of Health.
that target TBI prevention 
•  A harm reduction campaign with WorkSafe  
The Ministerial Group on Family Violence and 
New Zealand. 
Sexual Violence work programme focuses 
•  Cross-sector Child Injury Prevention  
on stopping family and sexual violence from 
Advisory Group. 
occurring and reducing harm caused by it. The 
work programme aims to improve and coordinate 
•  GP/Primary healthcare education.
existing services to ensure they lead to lasting 
•  Coaching education.
change, and make sure that people get the right 
service at the right time. ACC, as a member of the 
•  ASB St John in Schools 16 – injury prevention, first 
group, has a role in the follow-up response and 
aid, emergency preparedness and responding in 
long-term recovery. 
an emergency, with a focus on preventing TBI in 
As assaults are a strong predictor for TBI, ACC 
proposes to establish an intentional/non-accidental 
injury prevention work programme.
 15  Refer to Appendix 2 for more information on key injury prevention initiatives.
16  See

The following actions have been prioritised.
•  Maintain or improve the focus on TBI, including 
for Māori and Pacific people, within existing ACC 
injury prevention programmes. 
•  Consider how ‘unregulated’ sports can be further 
supported to implement injury prevention 
programmes that reduce the incidence and 
severity of TBI.
•  Establish a non-accidental injury prevention work 
•  Encourage the uptake of safer cars for young 
•  Reduce the incidence and impacts of motorcycle 
TBI has an overt focus in injury prevention 
programmes where TBI incidence could be reduced.
High-risk, low-volume sports that are unregulated 
are supported to prevent TBI.
Families with children know and understand the 
risks of falls in the home and respond appropriately 
to prevent or reduce those risks.
Those in the workforce delivering injury prevention 
interventions know how to reduce TBI and take 
action accordingly, and people are safer as a result.
TBI prevention interventions are person-centric  
and seamless.
TBI prevention via emergency services such as 
St John, Wellington Free Ambulance and the National 
Telehealth Service is connected and consistent.
Young drivers use safer vehicles. 
Motorcycle crashes causing TBI are reduced.  

Priority 2:
TBI prevention, 
diagnosis, treatment 
and rehabilitation 
are effective
Clinical staff recognised the importance of our whānau’s Māori cultural 
identity when my brother had a severe TBI. They introduced us to their Māori 
cultural advisor and included important cultural practices, such as Māori 
greetings, a two-way process of making connections (whakawhanaungatanga) 
and Māori cultural blessings (karakia), as part of being respectful (taha wairua) 
of our culture. Staff explained clinical terminology to whānau in a way we 
could understand (taha hinengaro) and used the Te Whare Tapa Whā model to 
develop a mutually beneficial relationship. 
They knew that although my brother had sustained a TBI requiring specialised 

healthcare to heal his body (taha tinana), the TBI also had spiritual (taha 
wairua) impacts that needed to be acknowledged and considered. 
The assessments had Māori content, which meant we better understood their 

relevance. Staff used these assessments and worked with us to develop a 
culturally responsive rehabilitation programme. The service embraced Māori 
cultural practices that were user-friendly and accessible to Māori.

However, some measures used in the sector are not 
comparable or shared between health providers, 
A range of specialised services support people with 
which makes it difficult to monitor a person’s 
TBIs in New Zealand. They include community-
progress and the overall effectiveness of services. 
based concussion services and specialised TBI 
rehabilitation provided in residential settings. 
Within existing measures little has been done to 
These services, together with injury prevention 
measure the experience of services. Measuring 
programmes and the Whole of Pathways TBI 
experience provides an opportunity to highlight 
Collaborative programme, create a good foundation 
and address aspects of the care experience that 
for further work to improve the effectiveness of TBI 
need improvement, meet people’s expectations, 
prevention, treatment and rehabilitation. 
enhance strategic decision-making and effectively 
manage and monitor healthcare performance that 
A strong focus is needed on improving access to 
can be benchmarked. 
services by Māori, who are overrepresented in 
statistics but underutilise current services. 
Government agencies work together to achieve an 
integrated approach 
One of the Government’s priorities is to deliver 
better public services. This has resulted in several 
Best practice informs nationally consistent 
work programmes that provide a good platform 
assessment/diagnosis and delivery of TBI 
for ACC involvement in targeting improvements 
services and support
related to TBI, including Better Public Services. 
Except for two recently developed Head Injury 
In particular, Result 2 Healthy Mums and Babies; 
and Concussion in Children pathways, there is an 
and Result 3 Keeping Kids Healthy (Ministry of 
absence of user-friendly clinical pathways that 
Health, June 2017).
are applicable to the New Zealand health context. 
Working across the sector provides an opportunity 
Improving the diagnosis and management of TBI 
to take a more holistic approach and address some 
requires a suite of clinical pathways that can be 
challenging issues shared by government agencies 
easily accessed and used. 
– eg identifying youth who may have undiagnosed 
Child protection processes are followed when 
TBIs that have contributed to criminal offences 
assessing and diagnosing non-accidental injuries. 
and led to their involvement with the youth justice 
system; and working with mental health services 
Services are culturally responsive and inclusive  
to improve rehabilitation outcomes among people 
of whānau 
with extreme, persistent behavioural symptoms. 
To meet the needs of Māori, TBI health and 
Through this work there may be an opportunity to 
disability services need to be reconfigured to include 
extend screening and services to the general prison 
a Whānau Ora option. 
Changes to service models should also consider the 
needs of Pacific people.
Outcomes and experiences of service delivery are 
collected and used to support improvements 
Outcome measures are important in assessing the 
status of a person’s recovery and rehabilitation. 
Information can help in monitoring progress, 
identifying effective interventions and demonstrating 
the effectiveness of services. Currently information 
on some functional outcome measures is collected in 
residential rehabilitation through the Australasian 
Rehabilitation Outcomes Centre. 

The following actions have been prioritised.
Clinical pathways drive national consistency 
•  Develop and implement a suite of national 
and best practice in service delivery. This in turn 
clinical pathways.
improves the diagnosis and management of TBI, 
including preventing re-injury through safe return 
•  Pilot a Sports Concussion Centre of Excellence. 
to activity and the delivery of effective rehabilitation 
•  Work alongside Māori to develop and implement 
programmes across the continuum of care.
a Whānau Ora model of service delivery. 
Māori and other cultures are able to receive a 
•  Establish a data and outcomes work programme. 
Whānau Ora TBI-focused service based on the 
cultural values and norms for whānau (rather than 
•  Develop a roadmap of services based on a 
individuals), empowering them using a strengths-
person’s journey through multiple agencies.
based approach to connect with a range of services 
•  Develop a directory of services used across agencies.
and support.
•  Establish a joint mental health and ACC programme.
The effectiveness of services in achieving client 
outcomes is measured through a national outcomes 
•  Determine the role of screening and management 
framework that spans each client’s journey.  
within the Ministry for Vulnerable Children, 
This includes measuring the client experience and 
Oranga Tamariki and the Department of 
their reported outcomes. This information is used to 
drive improvements. 
A broad range of services and support (not just 
health) typically needed by a person with TBI is 
readily identified throughout their journey. 
Behavioural needs following TBI are met through 
a partnered approach with mental health and 
ACC-funded services. 
Children and young people in the care and 
protection and youth justice systems have their TBI 
needs assessed and met at the earliest opportunity. 

Priority 3:
People with TBIs 
and their whanau 
experience good 
My partner had a serious TBI. He finished treatment after many months at a 
residential rehabilitation centre, then came home with a range of community 
support. At every stage the quality of care was very good. 
Eventually he became less in need of intensive clinical inputs, and one day these 

were finished. I found myself being his sole carer and I soon found the relentless 
role overwhelming. That’s when the enormity of the situation became apparent. 
I felt inadequate but still solely responsible. I thought I was able to handle it. I 
wasn’t. My partner who had been my rock was now my responsibility and had 
little insight into his situation. 
Fortunately, I was referred to a spouse, family and carers support group. 

Joining this group was a godsend, a tremendous relief. I realised that I was 
not alone and that the grieving cycle was a very good compass. I have made 
good friends and we continue to learn new coping skills together. Our injured 
partners and family members are included in activities we arrange as a group. 
It’s a more manageable life, not perfect but now supported by good friends 
who are on the same lifelong journey.

TBI services in New Zealand support the 
People with TBIs and their whānau understand 
achievement of good outcomes for people with TBIs. 
and adapt to their changing circumstances
Early detection to improve the management and 
Although informal support is important, outcomes 
reduce the severity of TBI is a current priority within 
for people with TBIs and their whānau will be 
the injury prevention concussion programme. The 
strengthened with formal programmes and 
TBI Strategy and Action Plan and the introduction 
additional resources. 
of clinical pathways will also have positive impacts 
The risks of further harm and injury are identified 
on reducing the severity of TBI. 
and mitigated for non-accidental injuries.
There are opportunities to improve services that 
Rehabilitation momentum is maintained 
extend to whānau, taking a more holistic approach. 
when people move within or between services 
As people’s responses to TBI vary, depending not 
and support 
only on their injury responses but their individual 
Work has been undertaken through the Whole of 
circumstances, it is important that they have 
Pathways Collaborative to improve transitions 
access to information and social support during 
between TBI services and create a more integrated 
their rehabilitation.
model. More work is required to extend this work 
programme, which also considers the role of 

The following actions have been prioritised.
People with TBIs and their whānau feel informed and 
•  Develop a group education programme for people 
prepared to meet the challenges that come with TBI. 
with TBIs and their whānau.
Through improved understanding and networking 
with others who have had similar experiences, they 
•  Develop a professionalised peer support 
gain knowledge that supports self-determination 
and the new ways of living needed in facing the 
•  Strengthen information about TBI for people with 
challenges associated with TBI.
TBIs and their whānau.
Information about TBI and what to expect is 
•  Develop an integrated service model that 
available in multiple languages and formats. 
supports transitions of care. 
When needed, people with TBIs and their whānau 
have ready access to people who can coordinate or 
facilitate transitions between services and access 
to other services and support (not necessarily 
health related).
Transitions between services and support are 
planned, with all the necessary information 
handed to the onward provider. This ensures that 
rehabilitation programmes continue uninterrupted, 
and people with TBIs and their whānau feel 
reassured and confident when things change.

Priority 4:
Workforce capability 
in TBI is developed
Twelve-year-old Susan had been admitted to hospital for a week with a 
TBI following a road accident. Prior to her discharge, a specialist in TBI 
rehabilitation provided Susan’s mother with information on Susan’s likely 
changes in behaviour and educational needs, advice on how to manage them 
and details of a contact person if she had any difficulties. A school meeting 
was also arranged to discuss Susan’s requirements for re-entry to school.
The school meeting was attended by Susan’s current teacher and an 

education specialist, trained in the educational needs associated with TBI. 
The group developed a plan for Susan’s re-entry to the school system. 
When Susan re-entered school her classroom teacher had undertaken TBI 

training, a modified education plan was in place and the teacher was fully 
aware of Susan’s potential difficulties (educational, social and behavioural). 
The classroom teacher had the support of a specialist teacher who could be 
called on if difficulties arose. 
Susan’s educational needs were regularly evaluated, with particular care 

taken to ensure that each teacher was trained in TBI and had someone to 
support them when they needed it. 

While there are specialised services available for 
Workforce resources and skills match the needs of 
preventing, treating and rehabilitating people with 
people requiring TBI services 
TBIs in New Zealand, not everyone with a TBI needs 
or receives them. 
Mentoring is an established and positive way of 
supporting people to improve their confidence 
Those in the health and disability services workforce 
and develop new skills in the work environment. 
and the wider government sector need a number of 
It is also effective in establishing relationships 
skills to work with people with TBIs – including the 
between people and organisations that strengthen 
ability to provide culturally appropriate services to 
communication and integrated ways of working. 
Māori and people from other cultures. Some simple 
but effective strategies, such as those already used 
Workforce capabilities in preventing TBI are 
for injury prevention, are needed. 
ACC has a separate work programme for its staff 
Government agencies and others working with 
that includes providing resources to support ACC 
people with TBIs improve their knowledge of TBI 
case owners in improving their knowledge of, and 
Teachers and educators have a key role in helping 
approach to, clients who have or are suspected of 
students to return to school after their recovery 
having a TBI. 
from TBI. Where return to school is part of a wider 
rehabilitation programme, teachers and educators 
need to support that programme.
Many government agencies are involved in 
providing services to people with TBIs. ACC will 
work to share its resources more widely with them. 

The following actions have been prioritised.
People with TBIs receive services and support from 
•  Use mentoring programmes to build skills in TBI 
culturally competent providers.
and cultural responsiveness.
People delivering TBI services and support are 
•  Identify and recommend key resources for 
knowledgeable and adapt appropriately to meet the 
rehabilitation following TBIs specific to different 
needs of people with TBIs. 
Resources that help different workforces to provide 
•  Contribute to building the capabilities and 
responsive and appropriate services to people with 
capacity of people from specific cultures and 
TBIs are identified and shared.
professional groups needed in the field of TBI.
ACC is actively involved in supporting workforce 
•  Support the development of specific 
capacity development among those from specific 
competencies in the wider TBI workforce.
cultures and professional groups needed for the 
delivery of TBI services and support. 
•  Develop resources to build teachers’ and 
educators’ capability to support students with TBIs 
Children returning to school following TBIs are 
returning to early childhood education or school. 
supported by teachers and school staff to achieve 
their rehabilitation goals.


Roadmap: Planning to support 
the implementation of actions
Priority 1: TBIs are prevented
Key points to implement
Maintain or improve 
Develop and implement a monitoring framework specific to 
the focus on TBI, 
TBI for each programme
including for Māori 
and Pacific people, 
within existing ACC 
injury prevention 
Consider how 
Identify unregulated sports 
Use the ACC injury prevention prioritisation process to 
sports can be 
determine next steps 
further supported 
to implement 
injury prevention 
programmes that 
reduce the incidence 
and severity of TBI
Establish a 
Review ACC’s current practices and policies to develop 
non-accidental injury 
opportunities to identify the risk of, and prevent further 
prevention work 
harm from, non-accidental injuries with ACC clients and 
Encourage the uptake 
Investigate the opportunity to encourage young drivers to:
of safer cars for young 
•  drive the safest family cars 
•  purchase safe cars
Reduce the incidence 
Increase the uptake of motorcycle training (prevention)
and impacts of 
Investigate opportunities to increase the wearing of full-
motorcycle crashes
faced motorcycle helmets
Actions led by:
ACC Injury Prevention

Priority 2: TBI prevention, diagnosis, treatment and rehabilitation are effective
Key points to implement
Develop and 
Partner with clinical pathway groups, expert clinicians 
implement a suite 
and others such as ambulance services and the National 
of national clinical 
Telehealth Service to support the development or 
enhancement of clinical pathways for:
•  adult assessment and management in primary healthcare
•  children’s acute management in district health boards 
•  rural locations
Review the adult acute management clinical pathway 
flowchart for district health boards, and promote its use
Support the evaluation of the Northern Region Head Injury 
and Concussion in Children pathway with the view to 
supporting its national adoption 
Recommend and promote awareness of clinical pathways 
Ensure that clinical pathway effectiveness monitoring 
includes achieving health equity for Māori
Pilot a Sports 
Complete a business case and evaluation plan supported by 
Concussion Centre of 
Describe the service required and supporting processes 
Implement and evaluate a pilot to determine  
next steps 
Work alongside 
Work with Te Pou Matakana and Te Pūtahitanga o Te 
Māori to develop and 
Waipounamu, and with interested stakeholders, to develop 
implement a Whānau 
a Whānau Ora model of service delivery that meets the 
Ora model of service 
needs of Māori whānau with TBIs 
Describe the scope, objectives and resources, including 
community relationships, required to implement the model
Complete any research or business cases required to 
support proposed approaches and the data needed to 
evaluate effectiveness 
Determine how effectiveness will be monitored and the 
model evaluated 
Complete service development, including supporting 
Test the Whānau Ora service model with the intention of 
national implementation 
Gather data to support an evaluation 
Evaluate and determine the next steps to inform a national 

Priority 2: TBI prevention, diagnosis, treatment and rehabilitation are effective 
Key points to implement
Establish a data 
Establish a project group (or link to the Whole of Pathways 
and outcomes work 
Collaborative work programme) 
Identify and engage with other government agencies 
(such as the agencies identified in this document and the 
Health Quality and Safety Commission) needed to support 
implementation and align with work in the wider health and 
social sectors
Determine what needs to be measured and what data is 
required and how it will be collected and used (include 
an analysis of data by ethnicity, deprivation, age, gender, 
disability and location) 
Consider the role of the person with TBI and their whānau’s 
experience of services as part of the data collection 
Consider the relationship between currently collected 
outcome measures and this work programme to extend 
Complete business cases and privacy impact assessments 
as indicated 
Ensure that infrastructure needs are met in order to implement 
Develop protocols and supporting documentation as 
Test, implement, review the results and refine 
Move towards benchmarking to support best practice and 
service improvements
Develop a roadmap 
Develop a conceptual map of the life course of people with 
of services based on 
moderate and severe TBIs to identify key points in the 
a person’s journey 
pathway where cross-agency involvement is likely to be 
through multiple 
Consider entry and re-entry to services and shared plans 
Consider how any legislative gaps between agencies can be 
addressed through policy 
Collaborate to publish and distribute roadmaps as 
Determine a process for keeping maps up to date and for 
monitoring effectiveness

Priority 2: TBI prevention, diagnosis, treatment and rehabilitation are effective 
Key points to implement
Develop a directory of 
Link with work underway in a cross-government project that 
services used across 
identifies the services and support available across agencies 
Identify processes for developing a common plan where 
multiple agencies need to interface with each other to 
support people with TBIs 
Collaborate to publish the directory as a resource for 
consumers and other agencies 
Determine a process for keeping the directory up to date and 
for monitoring its effectiveness 
Establish a joint 
Identify cross-government partners in this work programme
mental health and ACC  Describe the problems that are common to mental health 
and TBI services that could be better managed using a 
shared care arrangement. This includes people with mental 
health issues prior to their injuries and those that develop 
mental health problems after their injuries 
Review relevant literature 
Describe a programme to address the problems (including 
process mapping the current and future states)
Develop a pilot programme or introduce a new way of working 
Determine how changes to the current system will be 
Develop any business cases required
Implement changes 
Measure effectiveness, report and refine 
Determine the role 
Identify cross-government partners in this work programme
of screening and 
Review existing research related to screening for TBI in 
management within 
the youth justice population (Ministry for Vulnerable 
the Ministry for 
Children, Oranga Tamariki) and the adult justice population 
Vulnerable Children, 
(Department of Corrections)
Oranga Tamariki and 
the Department of 
Scope the opportunity/purpose and role of screening 
in the youth justice population (Ministry for Vulnerable 
Children, Oranga Tamariki) and the adult justice population 
(Department of Corrections)
Determine what tools would be used and when
Determine who would administer the tools 
Determine how data would be used to respond to screening 
Map a pathway for access to services for people identified as 
having TBIs requiring medical and/or social rehabilitation 
services funded by ACC
Consider a pilot programme to test the process and 
Determine the next steps following a pilot 
Actions led by:
ACC Provider Service Delivery in partnership with the Clinical Services 
Directorate and Injury Prevention

Priority 3: People with TBIs and their whānau experience good outcomes
Key points to implement
Develop a group 
Form a working group linked to the Whole of Pathways 
education programme 
for people with TBIs 
Review the Brain Injury Coping Skills Group programme and 
and their whānau 
adapt for New Zealand use
Identify resource requirements to implement the 
programme nationally
Determine demand for the programme
Determine how effectiveness will be measured
Develop a business case (if required) before contracting for 
the delivery of the service 
Contract and monitor effectiveness
Embed into business as usual activities
Evaluate effectiveness post-implementation 
Develop a 
Support research programmes currently underway to 
professionalised peer 
develop a TBI peer support programme
support programme 
Review international research and work undertaken to 
establish other professionalised peer support programmes 
in New Zealand
Work with Brain Injury New Zealand and other interested 
groups to develop a professionalised peer support 
programme that may include a facilitation component
Develop a business case (if required) before contracting for 
the delivery of the service
Contract and monitor the service’s effectiveness
Embed the service into business as usual activities
Evaluate its effectiveness post-implementation
Extend the Whole of Pathways work programme to further 
information about TBI 
identify and develop resources for whānau, including 
for people with TBIs 
interpreted resources
and their whānau
Determine the role of other information delivery methods, 
such as mobile phone applications
Develop an integrated 
Extend the Whole of Pathways work programme to develop 
service model that 
the transition work to establish an integrated service model
supports transitions 
Consider the role of facilitation and coordination in an 
of care
integrated service model
Actions led by:
Co-led by ACC Provider Service Delivery and the Clinical Services Directorate in 
partnership with Injury Prevention

Priority 4: Workforce capability in TBI is developed
Key points to implement
Use mentoring 
Partner with Māori service providers with health and/
programmes to 
or disability experience to develop and deliver a Māori 
build skills in 
mentoring programme to ACC suppliers that provide 
TBI and cultural 
services to people with TBIs
Partner with specialist TBI services to deliver a mentoring 
programme to general services that provide services and 
support to people with TBIs
Develop a business case (if required) and agree criteria and 
an evaluation method
Determine a procurement method and evaluate its 
Transition to business as usual if effectiveness is supported
Identify and 
Work alongside clinical experts and clinical pathway 
recommend key 
developers to identify key resources that ACC should 
resources for 
Develop a process for recommending clinical resources to 
following TBIs specific 
ACC suppliers
to different workforces  Work with other government agencies to identify their 
information needs relating to TBI, and share resources, 
including ACC’s internal TBI resources as appropriate 
Contribute to building 
Work with the sector to identify workforce needs specific to 
the capabilities and 
the Māori workforce and allied health workers (particularly 
capacity of people 
psychologists and speech language therapists)
from specific cultures 
Actively promote the recruitment of a Māori health 
and professional 
groups needed in the 
field of TBI
Determine how ACC can contribute to building workforce 
capacity in priority areas identified (particularly Māori, 
psychologists and services for children and young people)
Contribute to a whole-of-system response to building 
workforce capacity in areas of critical need 
Contribute to building workforce capabilities, promoting 
the inclusion of TBI prevention, diagnosis and management 
in training programmes (eg medical, nursing, social work, 
teachers’ colleges)

Priority 4: Workforce capability in TBI is developed (continued)
Key points to implement
Support the 
Review existing complementary competencies (eg Let’s Get 
development of 
Real) and development programmes that may assist the 
specific competencies 
wider workforce (including family carers) to develop access 
in the wider TBI 
to the specific skills needed when working alongside people 
with TBIs
Determine how ACC can support competency development 
in these areas and progress accordingly
Share with others resources being developed to improve 
ACC’s internal capabilities (as appropriate) 
Develop resources to 
Set up a working party with the Ministry of Education, 
build teachers’ and 
the Specialist Paediatric and Adolescent Rehabilitation 
educators’ capability 
Service and specialist children’s health and rehabilitation 
to support students 
community providers to develop resources to build teachers’ 
with TBIs returning 
and educators’ capabilities in supporting students with TBIs 
to early childhood 
returning to early childhood education or school
education or school 
Determine how the resources should be implemented and 
support the implementation
Determine how the effectiveness of such resources should 
be monitored and measured
Actions led by:
Co-led by ACC Provider Service Delivery and the Clinical Services Directorate in 
partnership with Injury Prevention

Appendix 1:  
Additional principles
Māori Strategy Diagram (pg 39)
Principles of Whāia Te Tika: ACC’s Māori Strategy
Whāia Te Tika will embed Te Tiriti o Waitangi principles within 
We uphold the Treaty of Waitangi 
operational practice. It will also pave the way for the future 
principles of: Partnership, 
protection of whakapapa through robust partnerships with Māori 
Participation and Protection
to mitigate the incidence of injury for Māori
Whāia Te Tika will allow ACC and Māori to have inclusive and 
We ensure the voice of our 
respectful korero. This includes the ability for Māori to be heard 
Māori customers is heard
in settings that is in keeping with their tribal tikanga
Our approach to engagement recognises the importance of kanohi 
We engage with Māori in a 
ki te kanohi, whakawhanaungatanga, and allowing for regional 
culturally appropriate and 
tikanga and kawa. This is to ensure that Whāia Te Tika is not seen 
responsive way
as a 'generic' Māori strategy, but one that is respectful of regional 
We will find what is working well for Māori in the community and 
use this to help us to remove barriers and increase access to 
We find what is working well 
services. Whāia Te Tika will provide ACC with a much needed lens 
and build on it 
for Māori related activity across the business. A single view will 
allow the business to identify pockets of success and promote best 
practice to a wide audience
Our actions are informed 
We will use an evidence based approach to identify the right areas 
by evidence
to focus on and invest in, and monitor and review performance
Whāia Te Tika becomes conversational, starting at the top of ACC, 
There is clear leadership 
as ACC becomes used to applying a Māori lens to our everyday 
commitment and accountability
activities. There is regular communication as part of decision 
making, and more transparency around performance improvement
And an embedded way of 
Whāia Te Tika becomes conversational at all levels of the business as 
working across ACC
ACC becomes used to applying a Māori lens to our everyday activities

Principles of the Convention on the Rights of Persons with Disabilities
1.  Respect for inherent dignity, individual autonomy including the freedom to make one’s own  
choices, and independence of persons
2.  Non-discrimination
3.  Full and effective participation and inclusion in society
4.  Respect for difference and acceptance of persons with disabilities as part of human diversity  
and humanity
5.  Equality of opportunity
6.  Accessibility
7.  Equality between men and women
8.  Respect for the evolving capacities of children with disabilities and respect for the right of children  
with disabilities to preserve their identities.
Principles of the United Nations Convention on the Rights of the Child (UNCRC) 
UNCRC gives children and young people up to the age of 18 the right to
1.  Life, survival and development
2.  The government making sure that the best interests of the child are taken into account when making 
decisions about the child
3.  Access to education and health care
4.  Grow up in an environment of happiness, love and understanding
5.  Protection from discrimination of any sort
6.  Develop their personalities, abilities and talents
7.  Protection from sexual exploitation, abuse and economic exploitation
8.  Special measures to protect those that are in conflict with the law
9.  An opinion and for that opinion to be heard
10.  Be informed about and participate in achieving their rights
11.  Special measures to protect those belonging to minority groups.

Appendix 2: Current high 
relevance programmes
Current key injury prevention initiatives underway with high relevance to TBI
Short description of the 
Partners in this work 
Relevance to TBI
Measures of success
Improving falls and 
Falls are the major 
•  Ministry of Health 
Outcomes framework 
fracture service 
cause of TBI in older 
•  Health Quality & 
with a dashboard to 
outcomes for older 
Safety Commission 
measure success, 
By preventing a fall, you 
including reductions in 
•  District health boards
A whole-of-system 
can prevent a TBI
fall claims, hip fractures 
approach targeting 
•  Primary healthcare 
and TBI
interventions to prevent 
•  Osteoporosis New 
falls and fractures and 
optimise rehabilitation, 
enabling people to live 
•  Local non-
well and independently 
in their own homes
organisations and 
community groups 
Sports Concussion in 
The appropriate 
•  Sports Collaboration 
New Zealand: ACC 
management of 
National Guideline
concussion decreases 
Evidence-based, best 
the risk of a secondary 
practice technical 
moderate to severe TBI
GP/Primary healthcare 
Contributes to a 
•  Sports Collaboration 
consistent standard of 
Education on best 
care and appropriate 
•  GPs
practice assessment 
rehabilitation for TBI in 
•  Conference 
and diagnosis of 
New Zealand
Coaching education
Appropriate early 
•  Sports Collaboration 
Education on the 
management of 
recognition of 
concussion can prevent 
•  National Sports 
concussion and roles 
more severe TBI and 
and responsibilities
ongoing symptoms
•  Secondary school 
sports coordinators

Current key injury prevention initiatives underway with high relevance to TBI
Short description of the 
Partners in this work 
Relevance to TBI
Measures of success
Safekids Aotearoa – 
One of the injury 
•  Safekids (and its 
Direct reach of 90,000 
Make Your Home a 
risks covered by the 
community coalition 
families (170,000 
Safety Zone 
programme is the risk 
children) per year 
Safekids is training 
of serious/catastrophic 
Interventions are 
community coalition 
head injuries caused 
proven to generate 
partners to deliver 
by falls. Safekids 
behavioural change in 
in-home injury 
community delivery 
prevention education 
partners will equip 
Success will also be 
to parents
parents with the 
skills, knowledge and 
gauged by a measurable 
Safekids also provides 
resources to prevent 
reduction in child 
resources for parents to  TBIs in children (aged 
injuries – particularly 
help them make simple 
serious head injuries 
changes to the home 
and TBI
Contributing funding 
Infant crying and 
•  Ministry of Health
Incidence of TBI 
to Ministry of Health 
•  Te Puaruruhau – 
to deliver Power to 
inability to deal with 
Auckland District 
this is a key risk factor 
Health Board 
The programme aims to  for violently shaking 
prevent the incidence of  babies, which can lead 
shaken baby syndrome 
to fatality or TBI 
in New Zealand through 
educating parents and 
caregivers of newborn 
babies on how to deal 
with stress and cope 
with crying babies
ASB St John in Schools
Concussion and 
•  St John
Reaching 480,000 
ASB St John in Schools 
TBI prevention and 
children, creating 
educators will be 
emergency response 
providing training 
are incorporated into 
understanding and 
in injury prevention, 
this training 
behavioural change 
disaster preparedness 
among children who 
and responding to 
receive the intervention 
an emergency to 
Success will also be 
480,000 preschool, 
gauged by a measurable 
primary school and 
reduction in child 
injuries – particularly 
school children from 
serious head injuries 
2015 to 2019
and TBI

Current key injury prevention initiatives underway with high relevance to TBI
Short description of the 
Partners in this work 
Relevance to TBI
Measures of success
Alcohol and drug 
Any future 
•  Health sector 
Strategic work is 
investments in alcohol 
underway around ACC’s  and drug-related 
response to alcohol 
harm prevention will 
and drug-related harm. 
be focused on the 
Work is in the early 
prevention of serious/
(discovery) phase, 
catastrophic injuries – 
which involves a sector 
which will include TBI
scan and understanding 
ACC’s role in the sector 
response to alcohol and 
drug-related harm
Suicide prevention 
Prevalence of ‘wilfully 
•  Waikato District 
Reduction in re-injury 
service design with 
self-inflicted’ head/
Health Board
and suicide mortality 
Waikato District 
neck/vertebrae injuries 
rates in the region
Health Board 
and concussions
This is a partnership 
with the district health 
board to understand 
gaps in services for 
people who attempt 
suicide or deliberately 
self-harm, and reorient 
services to improve 
patient outcomes 
in order to prevent 
re-injury and/or fatality
ACC’s child protection 
Assault is one of the 
•  Institute of 
Customer outcomes
and family violence 
known causes of 
Time to get right help 
prevention approach
TBI in New Zealand, 
Science and Research 
A co-design project 
with many assaults 
to understand ACC’s 
occurring within familial 
role in child protection 
settings. Reducing 
and family violence 
family harm through 
early identification and 
intervention will result 
in a reduced risk of 
resulting TBI

Current key injury prevention initiatives underway with high relevance to TBI
Short description of the 
Partners in this work 
Relevance to TBI
Measures of success
Plunket – injury 
Multi-phased capability  •  Plunket
Plunket staff trained 
prevention capability 
build of Plunket staff
and delivering a 
building programme
1. Board Injury 
consistent standard of 
Partnership with 
injury prevention 
Plunket to build the 
Framework – age and 
education to parents 
injury prevention 
stage appropriate
that is age and stage 
capabilities of its staff, 
appropriate as part of 
2. Capability build, 
who have direct and 
their Well Child service 
training all Plunket 
trusted access to 92% of 
to over 90% of 
staff to deliver injury 
babies (0-5 years) and 
newborns and their 
prevention that 
their families’ homes 
families each year
is age and stage 
each year
appropriate through 
Success will also be 
all Plunket channels 
gauged by a 
measurable reduction in 
kaiawhina, Plunket 
child injuries – 
nurses, parenting 
particularly serious 
education programme 
head injuries and TBI
etc.); initial modules 
will be on falls 
and shaken baby 
syndrome (both TBI 
prevention). Training 
based on deep 
customer insights 
and social marketing. 
Interventions will be 
targeted at parents 
and delivered as part 
of a broader social 
marketing programme 
about keeping babies 
The next steps of 
initiative scoping 
include developing 
Plunket’s capability to 
provide TBI support 
during recovery in the 

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